What to do??????????secretions..... - page 2
Ok, i've only been back in hospice for 3 months, but I have questions... 10 yrs ago, when I did hospice, our agency had a portable suction setup so should a patient be unable to handle secretions,... Read More
Feb 6, '07Occupation: med/surg/hospice/home health RN Specialty: 13 year(s) of experience ; Joined: Oct '98; Posts: 772; Likes: 293all in all, the family was quite thankful that I was there, especially when she was so gurgly and loud...they were calmer as she became more quiet...
Feb 6, '07Joined: Apr '00; Posts: 24,611; Likes: 35,453i absolutely despise suctioning.
and yet, so many use it readily and eagerly.
many times, the pt isn't even aware of what the ruckus is about.
if families only knew that half of these interventions are more for them than the pt himself....
Feb 7, '07Occupation: Case Manager Hospice Joined: Mar '06; Posts: 96; Likes: 17Personally, I do discourage suctioning and yes, really many, of not most, of the things we do is for us and the folks. When I carefully and s-l-o-w-l-y review the contents of the comfort kit, day 1 for me. I show the folks the atropine. Explain why it is packaged like eye drops, no, we don't use like eye drops. I call the juicy gurgles, audible respiratory secretions. Sounds clean and clinical. I explain that at the FIRST sound we are going to put 2 drops under the tongue. I then write "secretions" on the vial. When a pt is in a facility, I am matter of fact with all the staff I can talk to. "Call us if pt starts to have secretions you can hear." Even alert pt with lung cancer or other resp problems often benefit from a little atropine. If staff HAS to have a sx machine available. I make them cover it up and put out of pt/folks direct view. Who wants to look at that! I also tell Crisis Care staff that sx is to "vaccuum" out the mouth only. I also tell them a horror story about sx just to decrease their zeal for pulling up a tonsil. The key, newbies, is always think about two steps ahead. If you don't just flat out die, we're gonna get weak. When we get weak, we can't swallow and then we get..juicy.
Jun 28, '07Occupation: Med Surg Specialty: 14 year(s) of experience in Hospice, Med Surg, Long Term ; Joined: May '07; Posts: 151; Likes: 23We only use suctioning for bleeding problems. We don't use scopalamine patches either. We use levsin and atropine drops. The patches are expensive, levsin is effective, and suctioning is not considered "comfortable". At best, it takes the breath away. But, we all learn by doing or not doing, as the case may be. You stay as long as it takes to take care of the patient and family.
Aug 5, '07Occupation: Clinical Manager Specialty: NICU, Educ, IC, CM, EOC ; Joined: Jan '04; Posts: 137; Likes: 67Used atropine gtts when my Mom was in Hospice and had horrid noisy resps. It was really for me and my sibs, not her; she was peacefully oblivious to the whole issue. The Atropine didn't really help, btw. It just made me feel like I tried something.
Dec 28, '07Occupation: started in L&D ended in Hospice now "retired" Specialty: 30 year(s) of experience ; Joined: Dec '07; Posts: 122; Likes: 74very interesting to say the least! where i work we do use suction, some times i feel unnecessarily; i explain to concerned families suctioning a lot of times will increase the secretion production; i have had good results with levsin tabs (we used to use) then we switched to atropin drops; by the time we get to order scopolamin patches the patient often times does not need them any more, but they do work well;
i am surprised to read the use Lasix via nebulizer - i just got the royal ream out for using roxanol via nebulizer - any experience any one?
Dec 29, '07Occupation: RN Case Manager in hospice Specialty: 26 year(s) of experience in LTC, Sub-Acute, Hopsice ; Joined: Mar '06; Posts: 167; Likes: 130i just got the royal ream out for using roxanol via nebulizer - any experience any one?
I have used sugar free morphine for nebs for pts with severe SOB. It is useful at times. The last one was a patient with resp. failure at home on a vent. The pharmicist at Hospice Pharmicia was adament about the sugar free part. Although he did say that for the day it would take to get the sugar free morphine there we could use the Roxanol, but had to change the neb set up after each use. I think that it worked well for this paitent, calmed her down, calmed her resp rate (she was able to be with out the vent when awake and sitting up). It was actually a compromise with the (RN nurse practioner) daughter who wanted subqu morphine...a bit extreem and invasive in the opinion of me, the team and the medical director. I used Morphine via neb for patients in long term care prior to working in hopsice and found that it does work...for some. You need a pt that can complete the neb tx, actually takes in the med and blows it off. For someone who is not real compliant with the treatment it is not really worth it. And remember...STAY AWAY FROM THE NEBULIZER WHILE THE TREATMENT IS RUNNING. Had an aide pass out as she was holding the neb for the patient and breathing in the "steam". Thank God she was OK and not allergic to morphine!!!
Dec 30, '07Occupation: prehospital, hospice, clinic Specialty: 8 year(s) of experience in EMS, Clinic, Hospice, Corrections ; Joined: Dec '04; Posts: 22; Likes: 2Maybe there is some poor comm going on here.. in my hospice we use scop patches and atropine patches, and rarely a Lasix neb, and they do work effectively to manage sectretions
in pts that also have an existing condition that caused problematic increased secretions, in which case we have suction on hand and we use it when pt is "actively dying" just like before.
however it is real important to start early and agressively with the patches and drops, it sounds like you came into a stiutation where sectretions had been allowed to develop untreated for too long, I don't know how effective the patches or drops would be then, have not been in that situation, and perhaps that (how did that situation develop) should be part of your discussion and thought process, and what to change so it would not again. I am puzzled about " actively dying" comment. of course you treat the actively dying, whatever. ok,
I have the advantage of being in a hospice hospital, so care is more continuous, in that situation for us those treatments for us are amazingly effective.
I hope your meeting goes well, don't give up on this too quickly.
Jan 11, '08Occupation: Hospice Nurse Specialty: 3 year(s) of experience in Hospice, LTC ; Joined: Jan '08; Posts: 146; Likes: 475Oxyfast as well as MSO4 liquid can be nebulized for respiratory discomfort, they don't work systemically when used via neb and don't interact with the other pain meds. Never heard of the nebulized lasix, however am going to look into it.
Jan 11, '08Occupation: started in L&D ended in Hospice now "retired" Specialty: 30 year(s) of experience ; Joined: Dec '07; Posts: 122; Likes: 74is there any literature out there on using oxifast, morphine as well as Lasix via nebulizer????
Jan 11, '08Occupation: Hospice Nurse Specialty: 3 year(s) of experience in Hospice, LTC ; Joined: Jan '08; Posts: 146; Likes: 475Water based Morphine is the best opiod to use for resp discomfort, does not help with secretions and basically is a placebo type effect. Does not increase resp status, only allows pt to "feel" as if it has increased. Oxyfast works, though not as well. Have never tried lasix neb and will be researching this. Also will try to find some info on the opiod nebs.
Feb 11, '08Occupation: Hospice case manager Specialty: 21 year(s) of experience in Emergency, ICU, Psych, Hospice ; Joined: Jan '08; Posts: 58; Likes: 40Can you tell us more about nebulized lasix? What mg of lasix and in what vehicle? Are there any articles about this? It sounds interesting....and, effective!
Feb 12, '08Occupation: IM/Critical Care/Cardiology Specialty: compassion ; Joined: Sep '03; Posts: 1,555; Likes: 656I'm a nurse , albeit not a hospice nurse at this tme. Just wanted to comment on the lidocaine nebs, which I personally use for respiratory sx's. It does numb the epi/glottis area but I was switched fro m the oral apparatus (usual neb inhaler) TO A 2-PRONGED nasal apparatus. During an attack the blast (even tho it's a misty one( but when you are air hungry, I am swallow the thing to get relief)this allows the medication to of course go down I think deeper into toh bronchioles. It's interesting to hear this being used on the activlely dying. Are you using at first sign of secretions? Or even with the tenacious secretions? It does settle things down well for me thus the anxiety goes waaaaaay down when I can take that first complete breath. Just FYI from someone who uses this med/neb pretty often.
Sorry I misread the drug name on the post.
SharonaLast edit by sharona97 on Feb 13, '08 : Reason: misinformation